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2013 Review for Acupuncture Professionals

As 2013 was dawning, the WhiteHouse.gov petition to include acupuncture in Medicare was circulated by the AAAOM, NCCAOM, and loads of school and practitioners. Because coverage is not determined by the executive branch, over 30,000 signatures made no difference. That our professional organizations either didn’t know enough or didn’t care enough to educate acupuncturists about how the system works did give me the final push to create The Acupuncture Observer. From the first post last January through # 49 today, I’ve tried to provide thought-provoking strategic analysis of where we are and where we are headed.

The planned March AAAOM conference on a cruise ship didn’t set sail, making 2013 the second consecutive year without a conference. Things began looking up with April’s announcement that experienced professional Denise Graham was named AAAOM Executive Director.

However, by mid December, Ms. Graham and three Board members had resigned. (Previous ED, Christian Ellis, managed only three months in the fall of 2010.) A majority of the current board members have been appointed rather than elected. Something at the AAAOM smells. The Whistleblower Protection Policy, prepared in conjunction with the Confidentiality Policy adopted in April 2012, never resurfaced after it was pulled by then President Michael Jabbour (who is now managing the “operational transition”). We’ll probably never learn what is really going on in the board room, but 2013 marks the year I gave up hope that the AAAOM could become a viable organization serving the profession. It’s now become a single-interest (Federal legislation) organization, under the control of a small number of people, and without the resources to accomplish its priorities.

Throughout 2013 qualified LAcs were denied licensure by the Delaware Acupuncture Advisory Council’s insistence on the NCCAOM OM credential. New Florida regulations will limit licensure to those with NCCAOM Herb credentials beginning in October 2014, putting another state off limits to many practitioners and greatly increasing educational costs and the regulatory burden for those who intend to practice in those jurisdictions.

Outrage at P.T. Dry Needling continued throughout the year. Some LAcs made arguments that reflect poorly on our concern for the public, such as suggesting we’d drop our objections if PT’s agree to use hypodermic needles for this technique. Various state associations began efforts to redefine acupuncture and to push for discriminatory insurance policies in response to dry needling and the end of 2013 brought newcomer NCASI (and their lawsuit against Kinetacore) onto the scene.

Late Summer brought proposed policy changes from the NCCAOM that would move the group several steps closer to becoming a regulating rather than credentialing body. In a bit of good news, comments from the profession sent the proposals back to the drawing board.

Over the course of the year growing numbers of practitioners added insurance billing to their practices. We’ve been quick to throw stones at the billing practices (or rumored practices) of PT’s, yet many acupuncturists offer justifications for questionable practices and few seem clear on the exact nature of their agreements with the insurance companies.

In the waning days of 2013 a job opening for a Licensed Acupuncturist at Brooke Army Medical Center was posted on Facebook. Initial responses cast an interesting light on our profession’s self-regard. There were complaints that the salary (about 70k) was too low, some suggested that a PT would certainly get the job, and others complained about the requirement for a flu shot.

In a few days I’ll be back and begin looking forward. What will serve us in the year of the Wood Horse? When the dragon brings the energy of the spring back to earth, how should the seeds of the profession grow?

14 thoughts on “2013 Review for Acupuncture Professionals”

I think it is disgraceful that we will never be included in the health care system. That is not what I was told entering into school back in 1993. If I knew things were going this way I would have done it much differently. I already have a business degree and hate business which is why I moved in acupuncture to begin with. I am not of the same thinking as all of you but that is what makes horse racing. I do not want to treat just the elite individuals who can afford it. That thinking limits what you treat and the people who you come into contact with. I am now glad I decided to go back for OT school so that I can combine modalities and really get into the business of healing. I also liked the fact I will be hirable and they pay for my CEU’s, and health insurance. I am sick of being treated like a pseudo-professional. Sorry, you don’t agree but that’s life.

Susan — No apologies necessary. I certainly don’t expect all of us to agree, nor do I think we should all want to same types of businesses. And I do think it is a disgrace that you were mislead regarding the opportunities you would have. However, it is important that we are clear on what is true and what is rumor and what is opinion. For instance — the response to the petition didn’t say that we couldn’t ever be a part of Medicare, only that the petition wouldn’t do it. Secondly, we are already a part of the health care system. The VA hires acupuncturists, Kaiser hires LAcs, six states have acupuncture as an Essential Health Benefit, and there are hospitals that have acupuncturists on staff. Last, but not least, community acupuncture clinics are treating tens of thousands of people who are not “elite” individuals. I am sorry that you aren’t happy with the investment you made in an acupuncture degree and I wish you all of the best in your future as an OT, but acupuncture is already a part of the health care system and there are already opportunities for folks from all walks of life to receive treatment.

My plan is to do acupuncture treatment as an Ot working in pain management. I will work with a team of PT’s, MD’s and maybe other OT’s. I am looking forward to that. I am not giving up on acupuncture just adding to it. It was sold to me that we would get insurance and be health care providers. I do think that was the plan for many but it all fell apart and balls were dropped and many things occurred. I think there are lots of individuals who are disappointed. I don’t think I am the only one. I do think that the acupuncture schools have not been doing the right thing on many levels. I do think it will come back to haunt them. I do wish you the best as well and appreciate your response.

I did not sign that petition, nor I did not encourage my patients to. It was misguided, if not professionally embarrassing. It’s unfortunate that a CMS agent had to explain to us how things are done. I did not get the email, either. Probably signees and/or AAAOM members got it. Note that only 31,322 signatures were obtained. Considering that this number probably includes group batches obtained through signing campaigns, it doesn’t seem like all that many for a national effort.

The main point of the CMS response was that the agency simply cannot decide to include professional acupuncturists as providers. This is beyond their scope, as it requires Congress to amend the Social Security Act.

And thank goodness they aren’t considering including the procedure of acupuncture as a benefit, because that would mean someone besides an acupuncturist would have to provide it. That’s how the law is written. For this reason, we should _not_ lobby for acupuncture to be an EHB. In this case, alleged lack of evidence is a lifesaver, not an insult. CMS cannot help it if there is lack of evidence of the sort they need.

Lobbying for eyeglasses and dental coverage would do far more of a service to seniors than lobbying for acupuncture. Lack of these services is a glaring omission. There may not be enough of the right kind of evidence to show acupuncture is a necessary service, but surely eye and dental care are obvious necessities.

Your questions about how to decide what is medically necessary are valid, although I would prefer being compared to licensed professions requiring postgraduate education, such as chiropractic, physical therapy or naturopathy. As much as I respect good Reiki practitioners, it only takes a few weekend workshops with no prior education to become a “Master”.

Now that we have an official answer from the Centers for Medicare and Medicaid Services, perhaps we can put our efforts into developing viable practices based on our own creativity and work ethic. Maybe we can turn to issues that really matter to how we practice, such as the difficulty in obtaining certain herbs, inflated and expensive entry level educational requirements, fostering a sense of cohesive community within our profession, restrictive and politicized state regulations, and many more issues.

Let’s make the most of the Year of the Horse.
Happy New Year, everyone.

Thanks, you make some great points here. To clarify, EHB’s refer to benefits in private insurance plans and are currently set on a state-by-state basis. For states that opted to go with the Federal exchange the EHB’s were determined by particular plans in that state. The AAAOM did not understand the HHS proposal regarding EHB’s when they had their big letter writing campaign to demand that acupuncture be an EHB. (Surprised?)

As for medical necessity, necessity is (and should be) separate from who is providing the service. I don’t think everything an MD does is considered a covered service by Medicare. So, again, two different issues — Provider types (legislative control) and Medical necessity (administrative control). But, yes, I agree that while I know people who have had benefit from Reiki, it isn’t something I would want my tax dollars to cover.

And, absolutely, if we spent less energy tilting at windmills and more learning business skills, developing good educational and affordable educational programs, making it easier for practitioners to move from one state to another — why, we’d be in much better shape.

Today, I received an email about the White house petition that basically stated that they refused to make acupuncturists providers for medicare or medicaid. There reasoning was that there was no research to back up that what we did is a necessary medical service. It was truly absurd and insulting. I am sure you all received that same email. I was angry that I felt like voicing my feeling somewhere. I guess things in Washington is truly all about money and lobbying.

First of all, it notes that providers are determined by what is in the Social Security Act, and that acupuncturists are not mentioned in that Act. To add acupuncturists to the list of providers would require an act of Congress. One thing that is important about that is that if they had decided there was enough evidence to show that acupuncture was a necessary medical service, until we had an act of Congress naming us as providers all the acupuncture being paid for by Medicare would have to be done by providers other than LAcs.

I haven’t had a chance to review the NCD determining that acupuncture isn’t a necessary service — but I encourage you to ponder how such determinations should be made. Remember, our taxes pay for Medicare services. Is Reiki a necessary service? Homeopathy? Should patient or practitioner demand determine what is covered? Medicare does not cover eyeglasses or contact lenses or routine dental care — are they more or less necessary than acupuncture?

Yes, lobbying and money plays a role in these issues, but in this case, those who started the petition had no understanding of how the system works. The response to the petition in little more than an individual at CMS explaining how these decision are made.

Another footnote worth mentioning: After 3 straight years of legislation in Colorado, facing opposition from various fronts including acupuncturists during this time, finally lawmakers last spring finally allowed for mental health professionals to practice acudetox. This has already opened many doors for acupuncture to be more accessible in the state. Kudos to Dr. Libby Stuyt and her team in not giving up and working to build a broad base of support in collaboration with NADA-supportive acupuncturists over the past decade. Perhaps this law is the most progressive step for acupuncture in 2013?

It will be interesting to see whether the acupuncture community is willing to consider more individuals having access to acupuncture as a good thing or a threat? I expect the profession’s fears will take the reins….

Ryan —
Do you know how things are going in North Carolina since they required onsite LAc supervision of NADA sites? Are there still locations able to offer NADA detox?
Also, someone has been asking on Facebook whether the Ontario licensure laws have impacted NADA. Do you know?
Thanks.

Hi Elaine,
Sorry I didn’t get notifications of this comment/q to me just now reading it.

South Carolina is the state where AAAOM endorsed legislation requiring on-site direct supervision of ADSes by LAcs had near stamped out NADA programs in the state. It has been about 10 years since the Herbkersman law there passed. There have been NADA programs that have come and gone since then and none to my knowledge have sustained. One within a POCA clinic where the community acupuncturist supported the ADS so they could operate within the POCA clinic. Always interest and energy on behalf of ADSes and many mental health programs in SC to get NADA going. Always lack of funding within SC (as is anywhere on the map) to pay for an on-site acupuncturist to supervised directly for a mental health worker to insert 5 needles in the ear.

North Carolina has witnessed a bigger blow in recent years. Some acupuncturists in the state active within their board fought successfully against the medical board to oppose ADSes who were offering 5np within community health programs. Such a waste of energy on behalf of the acupuncture profession in this case again. Nothing good has come out of these acupuncturists’ efforts who have near squelched NADA programs in NC. But I believe Dr. Carter’s persevering and ongoing efforts in both NC and SC hold great hope for NADA programs. These fringe elements of the acupuncturist community can only oppose the progress of grassroots community health programs for so long before they alienate themselves.

NADA-trained paraprofessionals in Ontario may be among the most visible presences of acupuncture within mainstream western care in North America. There are well over 200 ADSes in the region. As the NADA conference featured last year, dozens of hospitals have incorporated NADA in Toronto. This group has organized well over the past year in response to the laws and to my knowledge most NADA programs won’t be affected by the recent acu law there.

For staying up on news of NADA policies, Guidepoints: News from NADA is the best source. Anyone seeking info can also contact NADA directly, facebook is not a good way to find information about sensitive issues like this: try acudetox.com you can call the NADA office directly to get info on where NADA workers can operate.

Thanks for the info. So sad when people who could be helped by a few needles are unable to access that help. And even worse when acupuncturists are the ones behind the lack of access. It’s important to be reminded of the real world consequences of some of our efforts to “save the profession.”

It’s interesting how efforts of a few to “save the profession” can have such a big impact. But equally culpable is the rest of the disenchanted, apathetic, disconnected acupuncture world that are too often either scared to speak up or just don’t really have time nor concern to invest into building bridges with NADA practitioners in their area, nor to really take the time to understand the role of NADA within their community. There are exceptions but the culture of US acupuncturists amidst this very insecure economic climate will be hard on public health programs that want to incorporate acudetox. Which is unfortunate as NADA practitioners can be a great ally for acupuncturists working to grow their CA clinics or BA practices.

Since I’ve been a kid I’ve thought about how it usually takes many people much effort to make progress, but a very few people can set things back so quickly. The building/destruction of the World Trade Towers being an egregious example of this.

It is incredible that so many acupuncturists seem to have a reflexive response for or against certain positions, and will put great effort into maintaining their position, refusing to even consider whether it makes sense. Certainly, the law in SC was celebrated as victory by the profession. I’ve also seen it among those practitioners who rush to support “higher standards” — whether that is requiring the NCCAOM herb exam of ALL LAcs or supporting NCCAOM control of CEU’s, etc. There is a lot of fingers in the ears and humming to avoid listening to other viewpoints.